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Work comp bill review survey – additional findings

Note – The public version of the First Annual Survey of Workers Compensation Bill Review will be released Friday. If you would like a copy, do NOT comment here, but send an email to infoATHealthStrategyAssocDOTcom.
I’m finishing up the survey report, need a break from analysis and writing – and some of the results are just too interesting to keep to myself till Friday. (I know, I need to get a life)
One of the less-obvious but more-interesting findings is the way the market’s perceptions about bill review firms have shifted of late. The industry has seen a lot of change at a rapid pace, with Mitchell’s acquisition of SmartAdviser, Coventry’s acquisition and ownership of the code for their bill review system, new management at Medata, CS Stars’ announced departure from the business, the purchase of Stratacare, and Ingenix’ troubles with UCR.
All of these events/transactions have influenced respondents’ views of the industry, and certainly of individual vendors within the industry. Some have risen in stature, while others have declined, and the changes aren’t necessarily what one would think.
One of the last questions in the survey asks respondents to rate each firm on a scale of 1-5, with 5 being best/highest. While respondents’ views of the various BR firms tend to lump them in a fairly narrow band, their statements paint a more complex and more nuanced view.
Couple the individual BR firm ratings with the responses to another question “is the bill review industry meeting payers’ needs?” and the picture that emerges is of an industry that is viewed in general as mediocre, focused more on processing speed and throughput than effective medical management (yes, bill review does have a lot to do with med management), and more reactive than innovative.
Among the vendors reviewed there are a couple notable exceptions, and it is important to note these views are general: depending on the payer’s market, technical abilities, business model, and strategic orientation, one or more vendors may be a great fit. The ‘fit determination’ process is key to successful vendor selection, and according to several respondents that had recently gone through the RFP process, requires much more interaction, discussion, and sharing of information on the part of the payer than they had anticipated. Instead of the typical RFI-RFP-finalists selection-onsite presentations-reference checking/offsite visits-battle over pricing and terms-contracting process, to a person these respondents talked about the need to engage much more deeply with potential bill review vendors than they had anticipated. In some cases this was acceptable to management, but in others a more rigid process prevailed, resulting in (in a couple cases) a less than optimal outcome.

Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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